We welcome questions from people who are visiting our website and the question I’m addressing today is…
“Dr. Riley, my MRI shows a bulging disc, pinched nerve, stenosis and some other issues, and I’m currently receiving injections. Is there anything you can do?”
We receive questions such as this on a daily basis from people seeking options. If you have a question, use the comment section in the blog post or contact us directly. I encourage people to use our website or consult with their own providers.
In response to the question, I will first give a brief description of exactly what the reader’s diagnosis means. An MRI is a diagnostic tool we use to determine involvement of a disc. The disc is a spongy substance between two vertebrae that provides cushion and space, and in this case, it’s in the neck. Time and posture can cause a disc to become injured and it begins to thin and narrow, causing more pressure on the joints. The question here concerns a bulging disc and pinched nerve, and this can reproduce pain elsewhere in the body. Sciatic nerve pain is a good example of this displacement because it stems from impingement or irritation to a nerve in the low back which then results in pain down the back of the leg.
The question also listed stenosis and although the word sounds complex, there is a simple definition of this condition. There are some holes on either side of the spine where two vertebrae form formina which are the little holes. The nerve comes through that hole and stenosis means narrowing of that hole. Stenosis is associated with degenerative joint disease and arthritis. To treat this condition, we need to reduce inflammation and many patients respond well to epidural steroid injections in the neck and low back. In a lot of cases, I work with pain management doctors to provide additional services lines in conjunction with the injections.
My Recommended Plan of Action
If the reader was my patient, I would first want to reach an accurate diagnosis before moving onto treatment. Since the MRI shows a bulging disc, pinched nerves and stenosis, she would most likely be a good candidate for a stabilization program and as a chiropractor, my focus would center on her limitations or restrictions in the joint and soft tissues. There may be degenerative problems and increasing stability would help take pressure off of the spine. Sometimes there are limitations in the upper thoracic spine or mid-back, so as a chiropractor, I would definitely take a look at that area as well.
We would start with physical therapy, probably through an intense cervical stabilizer program that would include specific exercises to wake up the cervical stabilizers. Patients in our clinic hear me use the word “facilitation” quite often and this means we need to turn those muscles “on.” Poor posture or long periods of sitting causes some muscles to stop working and many times, working with a trainer can relieve some of the symptoms. Once you begin training, the next step is strengthening those muscles so that the patient can begin doing exercises on their own.
How Will You Know the Treatment Plan is the Right One?
I consider the art of diagnosis a somewhat lost art these days, so I place emphasis on sitting down with a patient for 15 to 20 minutes and doing an extensive history with them to discover what treatments they might have had in the past. Another loss many in the medical profession seem to have suffered is the ability to listen to our patients. I want to look at the data they have, such as x-rays and images, and then examine the patient using our SFMA tests which were discussed in a previous blog, as well as other criteria to explore until we find the actual cause of their pain. Patients have a tendency these days to consult “Dr. Google” in an attempt to self-diagnose and many are surprised to discover their problems are far less serious than they imagined.
Following this initial examination, we discuss pain management or whether more imaging might be needed. If their complaint falls within our treatment parameters, we begin moving forward with the best solution to bring about pain relief and return patients to better stability and function.
Have a Question?
If you have a question you’d like answered, leave a comment below and we’ll answer you directly or write a blog post about it.